I saw a mother today for a prenatal consult who is due to have  her 5th baby
in December.  She struggled with milk supply with all  four previous babies.
Her children are 10, 8, 6 & 5.  All babies  have been born drug free at a
birth center and she hopes to deliver this baby at  the same birth center.  With
each baby there were little to none breast  changes both after and before the
birth. She had implants two years ago,  incision under her breast and behind
the muscle, because she had less than an A  cup and a wide spacing between her
breast.   Her medical hx is  unremarkable.

She has worked with several different lactation consultant with each  baby to
get her milk supply up with pump therapy, baby weight scale,  fenugreek,
reglan and used SNS with baby number 4 (the whole nine  yards).  She was never
able to pump much more than about 20 cc per  breast.  She seemed to feel she had
slightly more milk with each baby, but  she had to work really hard with each
baby and always had to use lots of  formula.

Are there any herbs or hormones that she could safely take while  pregnant
that could help in stimulation of more glandular tissue growth?   Goat's rue?
Progesterone (J Hum Lact 15(4), 1999 339-342)? Would blood level  test of
hormones be of any benefit to do now in determining if she has low  progesterone
(seems like she would have had hx of misscarriages)?  I did  recommend a thyroid
level test, just to rule it out, though no hx or  symptoms.

In today's consult, we  came up with a plan to be ready with a SNS at  the
earliest sign of baby not getting enough and to have an early visit with me
within the first 3 days after birth.  We discussed domperidone for after  the
birth.  Any suggestions for before or after the baby would be  appreciated.
Please reply to me privately as I am *no mail* on  Lactnet.

 Warm  regards,
Pat Lindsey, IBCLC - Lactation Services _www.PatLC.com_
(http://www.patlc.com/)


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